LESOTHO COMMUNICATIONS AUTHORITY
                               Application for transfer to new premises           
Rule 61 (1) and (2) of the LTA Rules of Practice and Service Provision

Physical Address : 6th Floor, Moposo House, Kingsway Road, Maseru 

Postal Address : LTA, PO Box 15896 Maseru 100 Fax + 26622310984  e-mail lta@lta.org.ls

1.PARTICULARS OF AN APPLICANT

1.1Personal particulars
Full name of an applicant ______________________________________________________________

Telephone Number ___________________________________________________________________

Fax No ____________________________________________________________________________

LICENCE PARTICULARS

Licence number _____________________________________________________________________

Period of licence _____________________________________________________________________

Type of licence ______________________________________________________________________
                                                              
Place of operation ____________________________________________________________________

___________________________________________________________________________________

Proposed place of operation ____________________________________________________________

___________________________________________________________________________________

Reason(s) for change of location ________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Attach any other relevant information that may assist the Authority in considering your application. (copy of the new sub-lease/tenancy agreement)

Fee M50.00

ACKNOWLEDGEMENT
•	The applicant acknowledges the statements in this form and accompanying documents will be relied upon by the Authority, and confirms that to the knowledge and belief of the applicant all such statements are true and correct.

•	The applicant undertakes to adhere to the terms and conditions of the licence as the Authority may prescribe.

Signature ________________________________________________________

Full names of signatory _____________________________________________

For and on behalf of ________________________________________________
                                                        Name of applicant